Summaries of health policy coverage from major news organizations

Emergency Departments at ‘Breaking Point’

The U.S. emergency care system is "at its breaking point," according to a study released on Wednesday by the Institute of Medicine, the AP/Richmond Times-Dispatch reports (AP/Richmond Times-Dispatch, 6/15). The three-part study was completed over two years by a 40-member panel of health care experts, who heard testimony from 60 individuals, wrote 11 commission papers and held 19 meetings (Sedlar, CQ HealthBeat, 6/14).

The study focuses on three areas of emergency care: emergency departments, the emergency medical system and pediatric emergency care (Fallik, Philadelphia Inquirer, 6/15). According to the study, the number of emergency department visits increased by 27% from 1993 to 2003 -- from 90 million to 114 million -- although the population increased by only 12%.

During the same period, 425 EDs closed, and the number of hospital beds decreased by 200,000, the study finds. As a result, many EDs are overcrowded and cannot provide the expertise required to treat patients with serious illnesses or injuries safely and efficiently (Brown, Washington Post, 6/15).

About half of ED visits are "urgent" and require lifesaving care, but many patients must wait hours for a physician and days for a hospital bed, according to the study (Philadelphia Inquirer, 6/15). In addition, the study estimates that, on average, one ambulance per minute is diverted from an ED because of capacity issues (Davis, USA Today, 6/15).

The study also finds that the emergency care system lacks the ability and capacity to address large disasters or disease outbreaks (Washington Post, 6/15). According to the study, "few hospital and EMS professionals have had even minimal disaster preparedness training" (Reuters/Los Angeles Times, 6/15).

Additional Results

The study finds that only 6% of EDs have all of the supplies required to provide care to children, although pediatric cases account for more than one-fourth of all visits. In addition, the report finds that the emergency care system is not standardized and that many ambulance services use radio equipment from the 1970s and cannot communicate effectively with hospitals and other first responders.

The study did not determine the number of patients who die annually because of problems with EDs but cited disparities in different regions nationwide (AP/Richmond Times-Dispatch, 6/15).

Recommendations

The study includes recommendations that "fall under four basic themes: improvements to hospital efficiency and patient flow; coordination and regionalization of the emergency care system with accountability for each component of the system; additional resources and greater consideration for the specific needs of pediatric patients, CQ HealthBeat reports (CQ HealthBeat, 6/14).

The study recommends that states and hospitals establish emergency care systems coordinated regionally to direct patients and help prevent overcrowded EDs (AP/Richmond Times-Dispatch, 6/15). In addition, the study recommends that Congress establish a new federal agency within two years to address the problems with the emergency care system (Washington Post, 6/15).

The study recommends that Congress allocate $50 million to reimburse hospitals for uncompensated emergency care, $88 million over five years to establish a network to provide regional care and $37.5 million for additional equipment and training for pediatric care (Philadelphia Inquirer, 6/15).

Comments

IOM President Harvey Feinberg said, "Every one of us ... has a stake in the state of our emergency care services. ... Yet as this series of reports makes clear, the emergency care that Americans receive can fall short of what they expect and deserve." He added that Hurricane Katrina highlighted "many deficiencies in our ability as a nation to respond" (CQ HealthBeat, 6/14).

Panel Chair Gail Warden, former head of the Henry Ford Health System, said that additional funds would not address three important problems for EDs: the aging population, the increased number of uninsured patients and the lack of access to primary care physicians (Philadelphia Inquirer, 6/15).

Robert Giffin, an IOM staffer who led the study, said, "There is such a gap between what the public knows, or what it thinks it knows, and the reality. And it's getting worse" (Washington Post, 6/15).

Rick Blum, president of the American College of Emergency Physicians, said, "This report should be alarming to the average American. It shows that emergency departments are struggling with very limited resources in their critical role as America's health care safety net. If we are to be truly prepared for the next big disaster or terrorist attack, we simply must get Congress to provide better support for out nation's emergency departments" (CQ HealthBeat, 6/14).

NBC's "Nightly News": The segment includes comments from Arthur Kellermann, chair of the Department of Emergency Medicine at Emory University (Bazell, "Nightly News," NBC, 6/14). The complete segment is available online in Windows Media.

NPR's "All Things Considered": The segment includes comments from Brent Eastman, a study co-author and trauma surgeon; Shirley Gamble, COO of the United Way Capital Area of Austin, Texas; Marianne Gausche-Hill, director of EMS at online. The complete segment is available online in RealPlayer.

NPR's "Morning Edition": The segment profiles an evening in the ED of Grady Memorial Hospital in Atlanta and includes comments from Kellermann (Silberner, "Morning Edition," NPR, 6/15). A transcript of the segment is available online. The complete segment is available online in RealPlayer.

NPR's "Talk of the Nation": The segment includes comments from Timothy Buchman, medical director of the trauma center and co-director of the surgical intensive care unit at Barnes-Jewish Hospital; Ricardo Martinez, assistant professor of emergency medicine at Emory University and executive vice president of medical affairs at the Schumacher Group; and Michael Roizen,division chair of anesthesia, critical care medicine and comprehensive pain management at the Cleveland Clinic and co-author of the books "You the Smart Patient" and "You the Owner's Manual" (Conan, "Talk of the Nation," NPR, 6/14). The complete segment is available online in RealPlayer. Expanded NPR coverage of the reports is available online.

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